New Requests

Principal Investigator

Title *

First Name *

Middle

Last Name *

Job Title *

Degree(s)

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Organization *

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State/Province *

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Phone *

Fax

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Address Line 3

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Secondary Investigator

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First Name

Middle

Last Name

Job Title

Degree(s)

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Organization

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Country

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Research Details

Amgen Contact

Research Proposal

Title of Research *

Each required field needs to be entered for proposal to be submitted (limit of 20,000 characters).

01) What is your hypothesis?*

02) What are your study primary and secondary aims?*

03) List all endpoints to be measured.*

04) Describe the method and provide a brief protocol.*

05) How will Amgen reagents be used?*

06) What is your lab's experience using the experimental system of interest (include recent publications)?*

07) How will your proposed experimental plan contribute unique data to the scientific field?*

08) If an Amgen Contact has been provided, has this Contact directly assisted in developing the Research Plan?

09) Detail in-vivo models, if applicable.

10) Please provide any supporting data (published literature, data from lab, etc.).

11) What is the Mechanism of Action/Mode of Action, if known?

Research Classification

Please select all appropriate for proposal.

In Vitro

In Vivo

Ex Vivo

Other (please specify)

Material Requested

Please provide details and calculations on how you obtained the specified quantity.

Material

Quantity

Calculations

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Animal Request

Please provide the animal model details. For breeding pairs, please denote separately the amount of males and females for each requested animal model pair.

Species

Gene/Allele

Background Strain

Zygosity

Qty

Sex

Age

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Dosing Regimen

If Amgen materials requested, please provide details and calculations on how you obtained the specified quantity which will be included for technical review.

Species

Requested Amgen Material

Amount per Dose

Species Weight

No. of Doses

No. of Animals

Total amount needed

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Documents

Please upload supporting documentation, if needed.

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